Practice Applications of Health Information Technology

8/7/2019 Practice Applications of Health Information Technology

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is the nursing specialty that deals with

human responses to life threatening

problems. It is a multidisciplinaryhealthcare specialty that cares for

patients with acute life-threatening illness

or injury.


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Process, store and integrate physiologic and diagnosticinformation from various sources.

Present deviations from present ranges by an alarm or analert

Accept and store patient care documentation in alifetime clinical repository

Trend data in a graphical presentation Provide clinical decision support through alerts, alarms

and protocols P

rovide access to vital patient information from anylocation both inside and outside of the critical care setting Comparatively evaluate patients for outcomes analysis

Present clinical data based on concept-oriented views(organize data by patient problem or by system)


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Physiologic monitoring systems:

Hemodynamic monitorsadvancedhemodynamic monitoring systems allow

for calculation of hemodynamic indices

and limited data storage. It can be

invasive or non-invasive.

Arrhythmia monitors computerized

monitoring and analysis of cardiac

rhythm have proved reliable andeffective in detecting potentially lethal

heart rhythms.


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Mechanical ventilators:

A mechanical ventilator is a machinethat generates a controlled flow of gas

into a patients airways. Oxygen and air

are received from cylinders or wall

outlets, the gas is pressure reduced andblended according to the prescribed

inspired oxygen tension (FiO2),

accumulated in a receptacle within the

machine, and delivered to the patientusing one of many available modes of

ventilation.


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Critical Care Information Systems

a CCIS is a system designed tocollect, store, organize, retrieve and

manipulate all data related to careof the critically ill patient. It is

focused on individual patients andthe information directly related to

the patients care. It is for the

organization of a patients currentand historical data for use by all

care providers in patient care.


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Components of CCIS:

Patient management

Vital sign monitoring

Diagnostic testing results Clinical documentation

Decision support

Medication management. Interdisciplinary plans of care

Provider order entry


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a synthesis of nursing practice and public

health practice applied to promote and

preserve health of populations.


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Home health care the provision ofpreventive, therapeutic, restorative and

supportive health care in the home. Public health the Institute of Medicine

(IOM) defines public health as coordinatedeffort at the local, state and federal levelswhose mission is fulfilling societys interest in

assuring conditions in which people can behealthy.

Focus on: Preventing, identifying, investigating and

eliminating community health problems

Assuring that the community has access tocompetent personal healthcare services

Educating and empowering individuals to adoptmore healthy behaviors


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Data Sets a uniform data set is a minimum set of items ofinformation with uniform definition and categoriesconcerning the specific dimensions of the service or practice

setting that meets the essential information needs of multipledata users within the scope of the service or practice setting.

Selected data sets:

Uniform data set for homecare and hospice the NationalAssociation of Home Care (NAHC) Resource Committee

initiated a task force to develop a uniform data set forHome Care and Hospice to achieve a standardizedcomparable home care and hospice data. The data set isorganized into two major categories of organizational andindividual level data elements.

x Organizational description of the organization, services,aggregate utilization and financial and personnel data.

x Individual demographic, clinical, service, andutilization data for clients/patients.


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Outcome and Assessment Information Set(OASIS) this is a group of items that

represents the core items of acomprehensive assessment for an adulthome health patient and forms the basis formeasuring patient outcomes for purposesof Outcome-Based Quality Improvement

(OBQI).

Outcome-Based Quality Improvement(OBQI) it includes two components,Outcome analysis and outcomeenhancement. Outcome analysis

Outcome enhancement


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Health Plan Employer Data and Information Set(HEDIS) -a set of standardized performance

measures designed to ensure that purchasers andconsumers have the information for reliablycomparing the performance of managed

healthcare plans. There is also a standardizedsurvey of consumers experiences that evaluatesplan performance related to customer service,access to care, and claims processing.


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Vocabulary languages-are validated clinical reference

languages, taxonomies or terminologiesthat make health care knowledge moreusable and accessible. The language,vocabulary or taxonomy enables aconsistent way of capturing, sharing andaggregating health data across sites ofcare. The vocabulary serves as a vehicle toformat messages that are exchangedbetween computer system and the codingand classification scheme used within themessages, for messages to haveagreement in syntax so that individual datacan be structured in a common way.


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The two most common nursing vocabulariesor taxonomies in use for CHN:

Clinical Care Classification (CCC) system- astandardized language/vocabulary consisting oftwo interrelated taxonomies the CCC of nursing

diagnoses and the CCC of nursing interventions(both Version 2.0). The CCC is designed todocument, code, and classify for computer-processing care in any clinical setting by any

health care provider using a standardizedframework. They are used to electronically trackand analyze patient care overtime across settings,population groups, and geographic locations.


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Omaha System is a researched based

comprehensive taxonomy designed to generate

meaningful data following usual or routinedocumentation of client care. It consists of threecomponents the problem classification scheme,intervention scheme and problem rating scale for

outcomes. The system provides a method forlinking clinical data to demographic, financial,administrative and staffing data.


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Community Health Intensity Rating Scale (CHIRS) was

a prototype classification tool that included 15

parameters that represented the same four homehealth domains as the Omaha System. Each of the 15parameters included patient profiles to illustrate the

extent of nursing input required for patient care for fourlevels of care contained within each parameter, for a

total of 60 profiles. A profile was selected for eachparameter and then the rater implicitly integrated these

into a categorical rating for the patients resourcerequirements. The ratings were as follows:

x Level 1-minimun requirement

x Level 2-moderate requirements

x Level 3 major requirements

x Level 4- extreme requirements


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Community Health Systemsconnotesthose computerized IT systems specifically

developed and designed for use bycommunity health agencies, local, andstate health departments, communityprograms and services. Community health

systems address the broad areas of healthcare programs, agencies, andsettings. They support health promotion anddisease preventive programs, statisticalinformation required by state/local healthdepartment programs and fundinginformation for federal block grants,categorical grants or other grant programs.


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The following are some of the typically usedsystems in community health systems:

Categorical systems

Screening programs

Registration systems

Management information systems

Statistical reporting systems

Public health information system

National Electronic Disease SurveillanceSystem

Special purpose systems

School health systems


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Home Health Information Systems home health

systems are designed to support home health care,

hospice and private duty programs provided byHome Health Agencies (HHA) such as VisitingNurses Association (VNAs), nonprofit HHAs andhospital-based programs. These systems collect

and process data and include applications onclinical service delivery, integrated financialfunctions, scheduling packages, decision supportfunctions, payroll, personnel management,accounts payable, billing functions, general

ledger, financial reporting and statistical reportingcapabilities.


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Telemedicine Systems communication

telemedicine systems link patients homes to

healthcare facilities and healthcare professionals,home care workers to their supervisors and patientand families with community resources. This allowfor reduction of inconvenient and expensive visits

to health care providers and omit unnecessaryvisits to healthcare facilities.


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Community health network system is an innovativeambulatory care system specially developed toprovide services by computer. Computer terminalsare placed in homes of heavy users of health caresuch as families with young children, pregnantwomen, disabled and the elderly. The system allowsthe subscribers to telephone for assistance andguidance on services offered via the terminal. Thesystem performs actions but not necessarilydiagnoses: Download the patient record from the hospital to the

home database Enters series of questions about symptoms using expert

system logic until the pathways are concluded Track self care and, depending on the responses to

questions, call or make an appointment with a clinician. Provide additional information on the condition if self care

is chosen to assist the client to resolve the problem.


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Home high-tech monitoring systems - are using

computers to link patients at home to health care

facilities. They allow healthcare providers tomonitor the progress of their patients. It allowstransmission of healthcare information being usednot only for diagnosis and treatment but also

prevention. The data is then reviewed by healthcare providers in the central station and arealerted for abnormal assessments/parameters for aparticular patient.

Another monitoring device is a remote defibrillator

that allows hospitals to diagnose and resuscitate ahomebound patient who had suffered a cardiacarrest.


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Sophisticated telemetry devices such as digitized x-

ray and ECG, electronic stethoscopes and

interactive video equipment are also usingtelecommunications technology to enablespecialists to examine patients in remote clinics.

Another is alert systems that allow the homebound

to signal for help in an emergency.


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Educational technology systems providecommunication linkages, information access, andeducational materials that meet the clients need

to reach beyond their environment. These systemsmay also offer screening for compliance withhealth prevention standards and linkages to

education


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As a response to increasing costs ofproviding health care, the healthcareindustry has moved away from theexpensive inpatient acute care

environment to caring for clients in variousambulatory care settings.

They include ambulatory clinics and surgerycenters, single and multi-specialty grouppractices, diagnostic laboratories, healthmaintenance organizations, independentphysician associations, birthing centers andcollege and university health services.


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Financial benefitsCost effective and timely bill submission process resulting indecreased days in accounts receivable and the reduction of

rejected claims. Administrative benefits

Reduction in the size of the record room, reduced to time spentfinding and delivering charts, increase in the privacy of data,formats that are legible and comply with legal regulations, andthe promotion of quality assurance and improved patientsatisfaction.

Ability for home access by physicians and nurse practitioners,alerts for incomplete data and integration of clinical data.

Clinical benefitsCan provide a problem list, automated, automated ambulatorycare provider order entry (ACPOE), a medication record, vital

signs, progress notes, results from the laboratory and radiologydepartments, flow sheets, growth charts, immunization records,medication allergies, profiles, alerts and reminders, and a follow-up system. Other applications for the clinical area canencompass a clinical decision support system, ePrescribing andevidence based medicine.


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Regulatory requirements

The ambulatory care arena just like other

health care requires data in order to managecare. The Health Care Portability andAccountability Act of 1996 requires 6 code sets.Behind the scenes, a database must bemaintained of all current coding schemes used

for the ambulatory environment. These include: Current Procedural Terminology 4th edition (CPT)

The Ninth Revision of the International Classificationof Diseases (ICD-9-CM)

The Healthcare Common Procedure Coding System(HCPCS)

The National Drug Code (NDC) managed by FDA

Code on Dental Procedures and Nomenclature


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The role of nurse using informatics conceptsin ambulatory arena user of the data contained in automated

systems, to take the data and put it together inmeaningful ways, making information.

reports are generated that can be used inbetter management of the health of the patient,managing the administrative aspects of thepractice, generating financial information, or inconducting research.

a nurse may be involved in the selection ofautomated systems based on a needsassessment of the environment.

the ambulatory nurse can be instrumental in theimplementation of an automated systemwhether administrative, financial or clinical.


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Member associations involved in ambulatory care

-the American Academy of Ambulatory Care Nursing (AAACN)

-the American Medical Informatics Association (AMIA)

-the Society of Ambulatory Care Professionals I

-the Federated Ambulatory Surgery Association (FASA)

-the American Association of Ambulatory Surgery Centers(AAASC)

-the Association of Ambulatory Behavioral Healthcare (AABH)

-the American Health Information Management Association(AHIMA)

-the Healthcare Information Management Systems Society

(HIMSS)

Accreditation organizations:

Accreditation Association for Ambulatory Health Care (AAAHC) COLA

The National Committee for Quality Assurance (NCQA)

The Joint Commission on Accreditation of HealthcareOrganization (JCAHO)


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eCLINICALLOG

The eCLINICALOG is part of an educational strategy, initiallydesigned to build data entry, analysis and synthesis skills innurse practitioner students. It becomes relevant to

undergraduate education as well. Like other logs, eClinicalogstarted out as a paper and pencil format. Nurse practitionerstudents used logs to track the number of patients seen inclinical practical and record basis demographic data,medical diagnoses, and medications prescribed.


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Decision Support Systemsto develop acomputer simulation model for city wideresponse planning for mass prophylaxis andvaccination during bioterrorist attacks andother public health emergencies.

Syndromic surveillanceIT systems can aidintensively in detection of a disease outbreakbefore the actual disease or mechanism oftransmission is identified. Example is the Real-time Outbreak Disease Surveillance (RODS)

system that provides early warning of possibleinfectious disease outbreaks caused bybioterrorism or other public healthemergencies.


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Helping clinicians respondit

contributes in providing training andeducation modules to teach healthcare

professionals to identify various biologic

agents. A system can also allow real-

time transmission of clinical impressions

and symptoms, which will aid in

bioterrorism surveillance.

Volunteers organizationused toorganize bulk volunteers, educate them

and how tasks are given.


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vendors are delivering more robust and tightly integrated clinicalsolutions that better address the needs of all care providers for morecoordinated, streamlined patient care delivery.

Unlike with earlier systems that primarily automated the paper chartand basic patient care processes, vendors are now expected to

deliver next generation clinical applications that: Support multi and interdisciplinary care with all provider orders,

care plans, and notes online and integrated in a commonpatient-centric patient record.

Promote data integrity via data validity checks and embeddedtools. Ex. Calculations

Provide ready access to internal standards. Ex. Policies andprocedures, drug databases, and reference guides


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Collect workload management data as byproduct of clinicaldocumentation including deriving prospective acuity data fromorders and retrospective acuity data from clinical

documentation.

Support productivity management, staffing and budgetingactivities.

Support process and outcomes monitoring, management, andcontinual improvement via standard reports and database

mining.

Support charge capture, supply management and inventory

reconciliation. Ex. Replenishment of supplies and medications asbyproduct of clinical documentation.

Support for medical, disease and population management.


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Key clinical system nursing and multi-disciplinary carecomponents

Patient Access Admission Assessments Diagnosis/Problems Nursing and Multidisciplinary Orders and Plans of

Care Integrated Plans of Care Kardex Workplans/tasklists Results

Clinical Documentation Discharge Summaries Summary Reports Outcomes Variance Reports

Practice Applications of Health Information Technology

Documents

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